Which nonpharmacologic therapy is commonly recommended for obstructive sleep apnea when CPAP cannot be tolerated?

• A. All of the above
• B. Oral appliance therapy
• C. Weight loss
• D. Positional therapy

Answer: (A)

When CPAP can’t be tolerated, several nonpharmacologic options are commonly recommended because they work through different pathways to reduce airway collapse during sleep. An oral appliance advances the lower jaw to keep the airway open, which can significantly reduce apnea events for many people. Weight loss can lessen the amount of tissue around the throat and overall airway narrowing, improving airway patency and daytime symptoms. Positional therapy helps if OSA is worse when sleeping on the back by encouraging side-sleeping, which often reduces the number of apneas. Because each approach has evidence of benefit and can be used alone or together, all of these nonpharmacologic options are appropriate considerations when CPAP isn’t tolerated.